Tapering/weaning off Effexor XR / Venlafaxine - Placebo or sensitivity?
August 28, 2018 4:44 AM   Subscribe

I have been taking Effexor XR 75mg / day for nearly 25 years since I was 15 years old. For the last year, I have been doing a ridiculously slow taper - 10 percent a month via a compounding pharmacy. From a pharmacological perspective, is there a dosage level where the medication stops working? What is actually happening when you get down to super small doses? Would also love to hear any fellow stories for those who have successfully gotten off this drug!

I have only tried to come off once nearly ten years ago, also a taper but a bit more aggressive - around 3 months. My anxiety came back with a vengeance almost immediately, so I went back on. Flash forward ten years, my life is in a much more stable place, and has been for some time. I've worked closely with my therapist and psychiatrist for years to achieve this goal, as I want to experience adult life without the filter of this drug. On top of that, the level of dependency is ridiculous. If I miss taking it even by an hour I get brain zaps, dizziness, etc. There's quite more to this, but for the sake of the question, assume every other aspect of my life is in order and thriving and this is an well-informed decision that has been in the works for many years.

After nearly a year of tapering, I'm now down to 5mg, (as you can't really do 10 percent down forever) and the plan is to go down 1mg a month for the next 5 months until zero. That said, I noticed that as soon as I hit the 6mg mark that my old anxiety / depersonalisation / rumination has started to bubble from under the surface, and even at this low level I find that I still get strange symptoms when I am late with a dose, and the prospect of making the jump to 0mg is now something I'm approaching with waning confidence.

Without a place like Crazymeds around anymore, it's hard to get some good anecdotal evidence here. Most people on other med / anxiety forums are in the middle of their own crises and you never hear the success stories there. While I am actively still working with a psych, I want to get some more anecdotal information.

To that end, my question is twofold, as I know meds are a hot topic here on the green, and there's some truly informed people here on the subject:

Firstly - from a pure scientific perspective, at this incredibly low dose (5mg) is the medication even doing anything anymore? With the XR formulation, it's made up of small beads that have to get weighed, and some beads are fillers, so it's possible that each dose is fluctuating slightly. I'm trying to get a handle on whether what I'm experiencing at the moment is because I am so sensitive to the medication that it's actually acute withdrawal, or whether the dosage is actually not doing anything, and I'm experiencing some sort of placebo.

Secondly - If you've read this far, it's probably because you have gone through this in some way yourself. If anyone here has successfully gotten of Effexor I'd love to hear your story either here or via MeMail. In those small instances where the anxiety flares up and I feel like I've made no progress at all, it would be great to have some glimmers of hope!

Thank you :)
posted by sxtrumpeto to Health & Fitness (8 answers total) 5 users marked this as a favorite
From a member who would like to remain anonymous:
I went on Effexor to help me during a particularly rough period. When I skipped a dose by mistake one day, I was so dizzy -- like room spinning dizzy, unable to see -- that I could not even stand up. Weaning was not possible according to the company timeline.
When I got down to their lowest dose available, I literally had to open up each capsule and count the beads each day. Each day I discarded a couple of beads and put the rest back into the capsule and swallowed it. During this time I sometimes tried to stop and would still discontinuation syndrome effects including horrible black depression that was clearly chemical. I'd continue on my bead by bead elimination process. Doing this took months. I was on the drug far longer than I wanted, but finally I was taking just perhaps a fifth of the beads and was able to stop without noticing any ill effects. Best wishes...
posted by taz at 5:18 AM on August 28, 2018 [2 favorites]

Honestly the effexor was so bad, I chose to take a different antidepressant with less withdrawl effects while tapering and then taper off that one later.

I'd say that logically it doesn't sound like it should, but man, fuck effexor.

At this point you may just want to stop because the dose you are on isn't anywhere close to therapeutic and your experiencing issues anyway. Instead of doing it five more times you could power through and be done but that's my opinion, not scientific.

I don't take any antidepressant anymore, so it is possible.

Take gentle care.
posted by AlexiaSky at 5:48 AM on August 28, 2018

My anecdote: I thought I was going to die when I went off Effexor for two weeks. I'm not exaggerating. I couldn't function. Then it went away and I don't think I died. I don't remember how much I was taking but 40mg sounds right. I just went cold turkey after trying to taper and feeling not good. I think you need to talk to a doctor.
posted by OnTheLastCastle at 7:43 AM on August 28, 2018 [1 favorite]

There is a solution to this, which is to get a bridging prescription for fluoxetine. That will stop the venlafaxine withdrawal symptoms; you can then come off the fluoxetine far more painlessly since it has a much longer half life (venlafaxine's short half life is the reason why it's so merciless on discontinuation).
posted by Acheman at 9:12 AM on August 28, 2018 [8 favorites]

You are getting terrible, awful IT'S ALL AWFUL advice in this thread. Acheman's answer is the one you should take to your prescriber for discussion. I 100% know from my own years with it that it isn't called Side Effexor for nothing, but you absolutely can get off of it painlessly with the Fluoxetine.

I noticed that as soon as I hit the 6mg mark that my old anxiety / depersonalisation / rumination has started to bubble from under the surface,

I hope you are able to accept that for some people, anxiety and depression is situational and the drugs are a bridge, but for other of us, they are the result of broken brain chemistry. All of the meditation, yoga, positive thinking and tumeric in the world isn't going to fix that shit, and for some of us, daily meds are what it takes to live life in a relatively steady state.

And if that's you, if you need to be on one psych drug or another forever, I hope you can give yourself permission to be fine with that. There's no medal for being meds-free.
posted by DarlingBri at 9:43 AM on August 28, 2018 [8 favorites]

I took this medication as an adult, from my late 20's to early 30's. The experience of a person who took it as a teenager for over 20 years may differ from mine.

I took non-XR Effexor for about 6 years, at 50 mgs/daily. It was mostly a migraine preventative for me, but did dull anxiety as well.

My psychiatrist had me just quit the 50 mgs cold turkey. I had a light schedule so I mostly slept and had horrible headaches. I also had 'static sounds' when I moved my eyes from side to side.

The worst withdrawal symptoms were gone in three days. I did feel some fatigue and depressive symptoms almost immediately, but it was wintertime. I also experienced the onset of serious, life-impairing anxiety about 3-6 months later.

The positive aspects of being off medication, were that I had much more energy and motivation. It was also very easy to lose weight compared to being on medication.

I found that getting my thyroid (TSH) and Vitamin D levels to a healthy range really helped with anxiety and sleep. However, I still occasionally use medication as needed.
posted by ElisaOS at 10:29 AM on August 28, 2018

I have two weeks to go in my 3 month-ish weaning off schedule. It's different from yours, but I think one should stick to the doctor's advice. I too have experienced really harsh side effects during this time, but I have not had even one anxiety attack or hint of depression, so I've felt OK with going on and trusting my doctor. He's been very supportive, too, and I've been regularly tested for all sorts of illness that the side effects resembled + obviously the issues with the side effects of the medicine. At this point, the side effects of weaning off are minor. I'm guessing I'll feel really bad in a couple of days, but then get over it, that has been the pattern till now. (My schedule: first halve the dose, cold turkey, go two weeks. Then skip one day for two weeks. Then skip two days for two weeks. Then skip three days for two weeks, etc. Now I'm at the first week of only one tiny dose pill on Friday. Here we can get weaning off half dose packages, so no bead counting).
The main thing, I think, is: are you experiencing side-effects of the weaning off drugs or are you getting anxiety problems because of the lack of drugs? For me, there is a clear difference, but I think the side-effects can take many different forms. When I feel bad, I feel dizzy, I feel like I'm getting a flu with fever, I have really bad digestive issues (in the beginning including a lot of blood in the stool, scary). I feel very tired. But not depressed or that terrible anxiety feeling.
Also, as mentioned above, the side effects of taking Venlafaxine are horrible too.

To those who hate the drug. I get it. But it has literally saved my life at a point, and I've recommended it to others. When I felt really bad, with anxiety attacks all the time every day, I couldn't care less about side-effects, and the drugs helped a lot.
posted by mumimor at 11:36 AM on August 28, 2018 [1 favorite]

Therapeutic range of venlafaxine is 75 mg + so I wouldn't expect effects to change at the 6 mg threshold - but withdrawal effects can occur.

IANAD and don't know your med history, but at that dosage venlafaxine is effectively a SSRI (you're below the threshold where it starts working on the norepinephrine receptors according to a couple studies; it's dose-dependent) and you might be able to bridge it with another SSRI as Acheman said.

When I went off venlafaxine for about three weeks I had involuntary muscle twitches but they faded in a couple of days.
posted by ahundredjarsofsky at 10:12 PM on August 28, 2018

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